Characteristics of Children with Communication Disorders (page 2)

Speech Sound Errors

There are four basic kinds of speech sound errors:

Distortions. A speech sound is distorted when it sounds more like the intended phoneme than another speech sound but is conspicuously wrong. The /s/ sound, for example, is relatively difficult to produce; children may produce the word “sleep” as “schleep,” “zleep,” or “thleep.” Some speakers have a lisp; others a whistling /s/. Distortions can cause misunderstanding, although parents and teachers often become accustomed to them.

Substitutions. Children sometimes substitute one sound for another, as in saying “train” for “crane” or “doze” for “those.” Children with this problem are often certain they have said the correct word and may resist correction. Substitution of sounds can cause considerable confusion for the listener.

Omissions. Children may omit certain sounds, as in saying “cool” for “school.” They may drop consonants from the ends of words, as in “pos” for “post.” Most of us leave out sounds at times, but an extensive omission problem can make speech unintelligible.

Additions. The addition of extra sounds makes comprehension difficult. For example, a child might say “buhrown” for “brown” or “hamber” for “hammer.”

Traditionally, all speech sound errors by children were identified as articulation problems and thought to be relatively simple to treat (McReynolds, 1990). Articulation refers to the movement of muscles and speech organs necessary to produce various speech sounds. Research during the past two decades, however, has revealed that many speech sound errors are not simply a function of faulty mechanical operation of the speech apparatus but are directly related to problems in recognizing or processing the sound components of language (phonology).

Articulation Disorders. An articulation disorder means that a child is at present not able to produce a given sound physically; the sound is not in his repertoire of sounds. A severe articulation disorder is present when a child pronounces many sounds so poorly that his speech is unintelligible most of the time; even the child’s parents, teachers, and peers cannot easily understand him. The child with a severe articulation disorder may say, “Yeh me yuh a da wido,” instead of “Let me look out the window,” or perhaps, “Do foop is dood” for “That soup is good.” The fact that articulation disorders are prevalent does not mean that teachers, parents, and specialists should regard them as simple or unimportant. On the contrary, as Haynes and Pindzola (2004) observe, an articulation disorder severe enough to interfere significantly with intelligibility is a debilitating communication problem; and articulation disorders are not necessarily easy to diagnose and treat effectively.

Phonological Disorders. A child is said to have a phonological disorder if she has the ability to produce a given sound and does so correctly in some instances but does not produce the sound correctly at other times. Children with expressive phonological disorders are apt to experience problems in academic areas, and they are especially at risk for difficulties in spelling (Clarke-Klein & Hodson, 1995) and reading (Larrivee & Catts, 1999).

Determining whether a speech sound error is primarily an articulation or a phonological disorder is important because the treatment goals and procedures differ.

Fluency Disorders

Normal speech makes use of rhythm and timing. Words and phrases flow easily, with certain variations in speed, stress, and appropriate pauses. ASHA (1993) defines a fluency disorder as an “interruption in the flow of speaking characterized by atypical rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be accompanied by excessive tension, struggle behavior, and secondary mannerisms”.

Stuttering. The best-known (and probably least understood) fluency disorder is stuttering, a condition marked by rapid-fire repetitions of consonant or vowel sounds, especially at the beginnings of words, prolongations, hesitations, interjections, and complete verbal blocks (Ramig & Shames, 2002). It is believed that approximately 3 million people in the United States stutter (Lue, 2001). Developmental stuttering is considered a disorder of childhood. It usually begins between the ages of 2 and 6, and 98% of cases begin before the age of 10 (Mahr & Leith, 1992). It is believed that 4% of children stutter for 6 months or more and that 70% to 80% of children 2 to 5 years old who stutter recover spontaneously, some taking until age 8 to do so (Yairi & Ambrose, 1999). Stuttering is far more common among males than females, and it occurs more frequently among twins. The prevalence of stuttering is about the same in all western countries: regardless of what language is spoken, about 1% of the general population has a stuttering problem at any given time. The causes of stuttering remain unknown, although the condition has been studied extensively with some interesting results (Bloodstein, 1995). Stuttering tends to run in families; but it is not known whether this is the result of a genetic connection (Yairi, 1998), an environment conducive to the development of the disorder, or a combination of hereditary and environmental factors.

Stuttering is situational; that is, it appears to be related to the setting or circumstances of speech. A child may be likely to stutter when talking with people whose opinions matter most to him, such as parents and teachers, and in situations such as being called on to speak in front of the class. Most people who stutter are fluent about 95% of the time; a child with a fluency disorder may not stutter at all when singing, talking to a pet dog, or reciting a poem in unison with others. Reactions and expectations of parents, teachers, and peers clearly have an important effect on any child’s personal and communicative development.

Cluttering. One type of fluency disorder is known as cluttering, a condition in which speech is very rapid, with extra sounds or mispronounced sounds. The clutterer’s speech is garbled to the point of unintelligibility. Hulit and Howard (2002) point out two differences between stuttering and cluttering: (1) the stutterer is usually acutely aware of his fluency problems, while the clutterer may be oblivious to his disorder; (2) when a stutterer is asked to pay more attention to his speech, he is likely to stutter more; but the clutterer can often improve his fluency by monitoring his speech.

Voice Disorders

Voice is the sound produced by the larynx. A voice disorder is characterized by “the abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an individual’s age and/or sex” (ASHA, 1993, p. 40). A voice is considered normal when its pitch, loudness, and quality are adequate for communication and it suits a particular person. A voice—whether good, poor, or in between—is closely identified with the person who uses it.

Voice disorders are more common in adults than in children. Considering how often some children shout and yell without any apparent harm to their voices, it is evident that the vocal cords can withstand heavy use. In some cases, however, a child’s voice may be difficult to understand or may be considered unpleasant (Sapienza & Hicks, 2002). Dysphonia describes any condition of poor or unpleasant voice quality.

The two basic types of voice disorders involve phonation and resonance. A phonation disorder causes the voice to sound breathy, hoarse, husky, or strained most of the time. In severe cases, there is no voice at all. Phonation disorders can have organic causes, such as growths or irritations on the vocal cords; but hoarseness most frequently comes from chronic vocal abuse, such as yelling, imitating noises, or habitually talking while under tension. Misuse of the voice causes swelling of the vocal folds, which in turn can lead to growths known as vocal nodules, nodes, or polyps. A breathy voice is unpleasant because it is low in volume and fails to make adequate use of the vocal cords.

A voice with a resonance disorder suffers from either too many sounds coming out through the air passages of the nose (hypernasality) or, conversely, not enough resonance of the nasal passages (hyponasality). The hypernasal speaker may be perceived as talking through her nose or having an unpleasant twang. A child with hypernasality has speech that is excessively nasal, neutral, or central-sounding rather than oral, clear, and forward-sounding (Hall et al., 2001). A child with hyponasality (sometimes called denasality) may sound as though he constantly has a cold or a stuffed nose, even when he does not. As with other voice disorders, the causes of nasality may be either organic (e.g., cleft palate, swollen nasal tissues, hearing impairment) or functional (perhaps resulting from learned speech patterns or behavior problems).

Language Impairments

Language impairments can involve problems in one or more of the five dimensions of language: phonology, morphology, syntax, semantics, and pragmatics. Language impairments are usually classified as either receptive or expressive. As described previously, receptive language impairment interferes with the understanding of language. A child may, for example, be unable to comprehend spoken sentences or follow a sequence of directions. An expressive language impairment interferes with the production of language. The child may have a very limited vocabulary, may use incorrect words and phrases, or may not even speak at all, communicating only through gestures. A child may have good receptive language when an expressive disorder is present or may have both expressive and receptive disorders in combination. The term language-learning disabilities (LLD) is sometimes used to refer to children with significant receptive and/or expressive language disorders.

To say that a child has a language delay does not necessarily mean that the child has a language disorder. As Reed (2005) explains, a language delay implies that a child is slow to develop linguistic skills but acquires them in the same sequence as normal children do. Generally, all features of language are delayed at about the same rate. A language disorder, however, suggests a disruption in the usual rate and sequence of specific emerging language skills. For example, a child who consistently has difficulty in responding to who, what, and where questions but who otherwise displays language skills appropriate for her age would likely be considered to have language impairment.

Children with serious language disorders are almost certain to have problems in school and with social development. They frequently play a passive role in communication. Children with impaired language are less likely to initiate conversations than are their peers. When language-disordered children are asked questions, their replies rarely provide new information related to the topic. It is often difficult to detect children with language disorders; their performance may lead people to mistakenly classify them with disability labels such as mental retardation, hearing impairment, or emotional disturbance, when in fact these descriptions are neither accurate nor appropriate.

Children with oral language problems are likely to have difficulties in both reading and writing. Catts (1993) reported that 83% of kindergarteners with speech-language delays eventually qualified for remedial reading services. The problem is compounded because children with speech-language delays are more likely than their typically developing peers to be “treatment-resistors” to generally effective early literacy interventions (Al Otaiba, 2001).